Jenny McCarthy's Anti-Vaccine Autism "Bulls**t"

Jenny McCarthy was recently on CNN's Larry King Live to talk about her experiences raising a child with autism. Apparently, it was Autism Awareness Week on CNN, and she is the national spokesperson of Talk About Curing Autism. Needless to say, she blamed her child's disease on vaccines. To be honest, I only watched the excerpted portions, not the whole program. However, from what I caught, McCarthy seemed to be relying on her personal story, stories from other parents, and uncited "statistics." I suppose this is a problem with cable news in general. In an effort to show both sides of any issue and have "balance," both parties are reduced to using sound bites without citing any true data, and viewers are left without any sense of which argument actually made more sense.




In the second half of the program, two pediatricians came on the program to discuss their viewpoint that there is no such link. That's when McCarthy unleashed her vast parenting and medical knowledge on them:

In the second half of the program, two pediatricians joined the program who didn't believe that there was a link between vaccines and autism, and McCarthy wasn't having any of it. "Are we considered acceptable losses?" she asked dangerously after a point was raised on the cost-benefit of vaccinations, and what they offered in terms of prevention. "Give my son the measles! I'll take that over autism any day." It was also around that point that she called the standard vaccination program "bullshit" without missing a beat. CNN deleted the expletive in the transcript but not on air, because they don't call it "Larry King Live" for nothing.

Hmm... who are you going to believe, two pediatricians with decades of experience, or a woman who is famous for showing her hoo-ha's in magazines and hosting a TV dating show and dating Jim Carrey (I think?). It's sad that I know that much about her actually. While her child's condition is unfortunate, McCarthy's lashing out at pediatricians and vaccines is a sign of denial and a desire to assign blame. The very idea that measles is somehow vastly preferable to autism makes no sense. Clearly, McCarthy is not familiar with some the complications of measles, like
subacute sclerosing panencephalitis. While the rise in autism is a cause for concern and further serious study is required, such sensationalization does more harm than good.

Still not convinced? Keep reading about the crusade against vaccines, or other interesting articles related to autism spectrum disorders.

Is An AIDS Vaccine Really Impossible?

Along with other recent articles, the NYTimes Editorial Board weighed in with a recent op-ed, suggesting that an AIDS vaccine is now considered seemingly beyond our collective reach:

Back in 1984, federal health officials, flush with excitement over discovery of the virus that causes AIDS, famously predicted that they would have a vaccine ready for market within three years. Now, after almost a quarter-century of toil and struggle, the effort has crashed in failure. No one yet knows whether a vaccine to prevent the disease will ever be possible.

Really? While difficult, the title of the piece somewhat contradicts with the content. As the op-ed goes on to state, funding must shift towards finding novel ways to combat AIDS as well as towards prevention / treatment, but should not forsake vaccine research altogether. However, the notion that a vaccine is "impossible" seems defeatist. By shaping public opinion against the notion of a vaccine, which in turn shapes the opinions of those in government and elsewhere who approve funding for such projects, I think pieces like this do more harm than good.

The Crusade Against Vaccines

A recent NYTimes article nicely portrays the stealthy rise of parents withholding vaccinations from their children for non-religious personal beliefs. These "vaccine skeptics" believe they are taking some kind of enlightened view of vaccines as dangerous tools of pseudoscience. As the article notes, the parents are falling prey to a form of information asymmetry:

“The very success of immunizations has turned out to be an Achilles’ heel,” said Dr. Mark Sawyer, a pediatrician and infectious disease specialist at Rady Children’s Hospital in San Diego. “Most of these parents have never seen measles, and don’t realize it could be a bad disease so they turn their concerns to unfounded risks. They do not perceive risk of the disease but perceive risk of the vaccine.”

This misperception of risk leads to comments from parents like this:

“I refuse to sacrifice my children for the greater good,” said Sybil Carlson, whose 6-year-old son goes to school with several of the children hit by the measles outbreak here. The boy is immunized against some diseases but not measles, Ms. Carlson said, while his 3-year-old brother has had just one shot, protecting him against meningitis.

“When I began to read about vaccines and how they work,” she said, “I saw medical studies, not given to use by the mainstream media, connecting them with neurological disorders, asthma and immunology.”

Ms. Carlson said she understood what was at stake. “I cannot deny that my child can put someone else at risk,” she said.

I can see how reading random misleading websites about the link between vaccines and autism can lead to confusion and skepticism, but what is sad is that these parents are not typically poorly educated. They have the means and intellect to seek out proper information and discuss the choice. Instead, they seem to buy into the fear and paranoia to the detriment of not only their own children, but other people's children as well.

As a public health issue, this is quite alarming. Vaccines work not only due to immunologic principles but also social ones. The social aspect is due to the herd effect, where increasing immunization rates help protect those who are not immunized yet or have poor immunity. If parents do not vaccinate their children, the effect is potentially much larger than merely having their own child get sick.

Stories like this lead me to believe more and more that, in addition to lamaze classes, new parents should be required to take classes about how to care for their impending bundle of joy. The classes would not only teach basic parenting skills (simple things like... babies should drink milk, not water), but also important ideas like the value of vaccinations. If the parents-to-be do not take the class and do not pass a basic test, then a relative who has previously passed the test or Child Protective Services should take custody of their children until they do pass the test.

Radical? Maybe, but think about it: we require such testing before people adopt children. The state also requires testing before one is allowed to drive. The idea in both cases is that these activities can potentially harm other people, so the state wants to ensure that people are capable before entrusting them with the responsibility. Why should parents of natural-born children be any different? As the issue with vaccines and many other cases of poor parenting show (ahem, Britney Spears?), there is a role for the state to play here.

The Consumer's Favorite Doctors?

Consumers visit "doctors" all the time while shopping. A funny post over on mental_floss discusses the medical backgrounds of these doctors, specifically Dr. Brown, Dr. Scholl, Dr. Martens and Dr Pepper. As one thinks about this type of branding, it reflects how America's attitudes towards physicians have changed over the past 100 years. At the turn of the century, doctors were seen as respectable members of society who were authorities on a wide range of subjects. The title 'doctor' had influence. The logic of marketing dictates that manufacturers would not have branded something "Doctor X's Tonic" or whatever unless the label "Doctor" added some value. Would you buy a drink called "Sergeant Pepper" (heh)? A shoe insert named "Commodore Scholl's"? I think not.

However, society today views physicians differently. Popular media shows physicians as on edge, as we often are. Or, perhaps worse, as being ditzes and sex-starved (um, as we often are?) People are skeptical of their doctor's advice, and often turn to the internet or other non-traditional sources for advice. Why the change?

It seems that the seeds of medicine's demise were sown in medicine's success. As one of my attendings on surgery mentioned, the advent of modern medicine changed people's expectations. His father had been a pediatrician prior to the days of vaccines. Many children would be stricken by diseases such as polio. Parents were fearful, and physicans often provided a calming presence, even if they could not provide any solutions. In some sad cases, patients would even die, but no one would blame the pediatrician, but rather in fact would sing his praises at the funeral.

Then, vaccines arrived. Over time, parents stopped seeing the crippling effects of diseases like polio, and rather were left to deal with crying babies and sore arms. Instead of seeing the physician as an authority, people (especially the kids) came to see the pediatrician as someone unduly inflicting pain. Over the decades, this has led to people even questioning the rationale behind vaccines. Of course, vaccines are not necessarily 100% safe, and physicians and parents should remain vigilant. However, this is not tantamount to rolling back decades of progress against diseases by arguing that vacccines are harmful.

Of course, the story is anecdotal, and only one part of the issue. The "evolution" of the American healthcare system, dramatic shifts in the structure of society, and increased consumer awareness have all served to tear down the pedestal upon which doctors once stood. While it may be beneficial for sodas and shoe inserts to have "doctors" tied their brand, physicians should be mindful of their own 'brand' and how it is perceived in the marketplace of society.

Organ Donation: The "Gift" of Life?

During one's medical training, the subject of organ transplantation becomes inescapable. For myself, I've encountered it at least twice, both during my two weeks on the liver transplant team, as well during my month on the renal service during my internal medicine rotation when I went to the transplant clinic. On the surface of it, organ transplantation is one of the great successes of modern medicine as well as seemingly straightforward ethical proposition. However, after closer examination it becomes clear that organ transplantation, while still being a net positive, is not as straightforward as one would like it to be.

The article "Desperately Seeking a Kidney" in the NYTimes highlights many of the main issues. The article is written by a psychiatrist who was seeking a kidney transplant. She describes what led her to be a candidate for organ transplantation, her time on the waiting list, her quests to solicit family, friends, and eventually strangers for a donation, and how the process affected both her and her potential donors. As medical students, we often deal with science of transplation, such as the immunology behind organ rejection, and the pharmacology.

Organ transplantion is encouraged by many groups, often as the "gift of life." And while I still believe that organ donation is a positive action and should occur, I must confess my own misgivings about the process, especially given the experience in the article above. In my mind, the ideal solution would involve using stem cells or some other synthetic process to provide a replacement organ, making donation virtually obsolete. Of course, this is not reality (yet, anyway). So, we are left with donation as it is. As the author discusses, in the U.S., organ donations are "gifts" by definition, as there is no other legal way to obtain an organ. However, this leads to the "tyranny of the gift," as she describes: the burden the donor feels about being obligated to make a donation, the indebtedness the recipient may feel towards the donor. It should be noted that in the majority of the cases, organ donors view the experience positively, but it still important to consider the psychological aspect of donation.

To play devil's advocate for a moment though, I wonder why we impose a system of donation that requires that organs be a gift. I understand that potential for corruption, but the U.S. has a tradition of free markets, and there is a clear market here with a well-defined demand and supply. Of course, the market could not be completely 'free,' but it perhaps could be much less 'deregulated' than it is right. Currently, my understanding of the transplant system is that organs are listed on a list on the national registry (United Network for Organ Sharing, or UNOS). Potential recipients are ranked on a list; the ranking is based on various criteria that vary by organ. When a recipient is at the top of the list, they get the first shot at an organ. The donors are anonymous unless the recipient brings their own donor (such as a sibling). Now, imagine a similar system with anonymous donor-recipient pairings, but instead of giving a 'gift,' people are allowed to bid on organs. There are several benefits to this system, especially in light of the psychological issues discussed above. First, by offering compensation for organs, this could potentially expand the pool of potential donors, leading to more lives being saved. Second, by making the donation a transaction instead of a gift, it is possible that people would have less psychological hangups, and would view their donors as merely someone who they made a deal with, such as a car salesman, instead of their 'life savior.' Lastly, by putting a price on the organ, in theory, this would help curtail the black market for organs (okay, maybe not, but in theory, it would help).

The obvious problem here is that richer recipients will be better able to purchase an organ. However, perhaps this could be mitigated by utilizing the ranking system to weight dollars of people in greater need more highly. Still, I think most people would find the system unsavory, even if it were to lead to a net increase in organ donations. Perhaps a system utilizing a Dutch auction, or even one in which there is a fixed price for organs (such as the 'market' in place for the eggs of smart, young women with a college degree from an accredited institution) may increase the amount of donation.

The system in place, while less than ideal, is the best compromise between ideals and practicality. However, I think the notion of the market is interesting to consider because, depending on how science advances, we may one day have to ponder what the price of a synthetic organ should be.

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